DESCRIPTION: The overall goal of the Yale OAIC is to enhance the likelihood of successful aging as shown by the maintenance of physical, social, psychological, and cognitive function in elderly persons. Within the context of this goal, over the next five years the center will: 1) conduct IDSs to determine the efficacy of impairment-based interventions at preventing specific disabilities; 2) conduct studies to better understand the pathophysiology of disabling conditions by exploring the mechanisms of response to interventions; 3) develop and refine methods to conduct trials of promising interventions; 4) train young investigators capable of conducting studies of promising interventions; 5) facilitate collaboration among investigators withexpertise relevant to understanding disabilities; and 6) translate research findings into improved health care for older persons. The four IDSs proposed for the renewal include a trial of PREHABilitation strategies for at-risk elders, with Dr. Thomas Gill as PL; a driver-related rehabilitative intervention for the elderly, with Dr. Richard Marottoli as PL; use of attention training to enhance driving skills with Dr. Emily Richardson as PL; and a study of the mechanisms of insulin resistance in older persons, with Dr. Gerald Shulman as PL. A key aim of each IDS is to explore the mechanisms which underlie the effects of the intervention in order to determine the "disabling process". This is established in the third study by determining the intermediary (mediating) response variables. In the fourth study, state-of-the-art nuclear magnetic resonance (NMR) and stable isotope technology will provide insights into the pathogenesis of insulin resistance in aging, and the mechanisms by which various interventions might influence this process.